Elliot, a seven-year old boy, is brought to the emergency department after six days of fever and lethargy. He has a rash, diarrhea and decreased urine output. Both his parents are healthcare workers with possible COVID-19 exposures.
Agitation and Aortic Dissection
A 53 year old male with untreated hypertension presents with a history of vomiting, back pain and acute agitation. Once he is sedated, assessment will reveal an acute aortic dissection. He will require prompt treatment, intubation and disposition planning.
COPDE with Pneumothorax
A 68-year old man with COPD requiring home oxygen presents with respiratory failure. He is hypoxic, hypercarbic and agitated and will require intubation. Dissociative-dosed ketamine and BiPAP can facilitate pre-oxygenation. After a successful intubation, the high pressure alarms on the ventilator will go off. The team leader must troubleshoot the high ventilation pressures until they find and treat a tension pneumothorax.
TB Pericarditis
A 38 year-old man (Ethiopian refugee) with untreated HIV and past history of TB, presents to the emergency department (ED) with anterior chest pain, shortness of breath and hypotension. He was seen 3 days prior by a walk-in clinic and referred to the ED with chest pain and ECG showing pericarditis, but did not attend the ED until symptoms were severe. In the ED, patient quickly progresses to profound shock and has a PEA arrest. POCUS will show a large pericardial effusion and tamponade. Team members are to initiate CPR, manage the arrest and treat the effusion using bedside pericardiocentesis in order to obtain return of spontaneous circulation (ROSC).
Urologic Sepsis
Denise is a 59-year-old female who presents with a 7-day history of urinary symptoms, fever, and left flank pain. She has a history of STEMI 5 years ago with chronic left-sided heart failure. She becomes unstable in the ER, requiring judicious fluid resuscitation, vasopressors, and empiric antibiotic treatment. The team leader needs to consider the history and arrange renal imaging to discover the severe sepsis is secondary to an infected ureteric calculus. From there, emergent urologic consultation and admission to hospital is warranted.
Local Anesthetic Systemic Toxicity
A femoral nerve block has just been performed on a 65-year-old male who sustained a right femoral neck fracture. The patient also sustained a laceration to the scalp which was repaired by the medical student. The patient is now complaining of blurry vision, paresthesias, and “twitchiness”. The patient progresses on to seizure followed by cardiac arrest and will need high quality ACLS care along with lipid emulsion therapy.
Hypercalcemia of Malignancy
This case was written by Dr. Skye Crawford and Dr. Nathan Ashmead, academic emergency physicians at the University of British Columbia. Why it Matters Oncology patients often present a challenge to healthcare providers in the emergency department. They have complex medical needs, both from their underlying illness and from the surgical, medical and radiologic treatments … Continue reading Hypercalcemia of Malignancy
Simulation Literature
This week's post is a bit different. It's not a sim case but rather a chance to delve into some of the amazing academic work that has been done in the simulation world over the years as a foundation to how and why we sim. I recently found myself wondering, what would be the top … Continue reading Simulation Literature
Unstable Atrial Fib
This case was written by Drs. Pittman and Bridges, emergency physicians at Prisma Health-Upstate in Greenville, SC. They both teach in the University of South Carolina School of Medicine-Greenville and in the emergency medicine residency program. Dr. Pittman is the residency Director of Academic Success, completed residency at the Georgetown / Washington Hospital Center Emergency … Continue reading Unstable Atrial Fib
Virtual Resus Room
Physical distancing restrictions during the COVID-19 pandemic have dramatically impacted medical education, challenging educators around the world to create interesting, novel ways to engage learners remotely. Virtual alternatives to in-person simulation sessions have been of particular interest. From discussion with other educators, it seems like many programs have shifted to a model of sim that involves talking through challenging cases. This strategy is excellent for medical content review but misses the hands-on, interactive, nervous energy of simulation that makes it so valuable. This is why we set out to create the Virtual Resus Room.
